Adult NP practicing in BH/psych?

Sailrmar9 · Feb 16, 2017

Looks like I have sparked a lively debate! Thank you for all of your feedback. I certainly appreciate all of the feedback. Trust me, I am not trying to discount the additional education and training of NPs specializing in mental health. Like many of you, I do recognize that this is a shortage area. Yes, in primary care we do manage depression and anxiety. No, I am not treating the patient who is bipolar, schizophrenic, etc. I am no prescribing mood stabilizers, anti psychotics, etc. To compare, I'll use the example of managing hypertension. In primary care I would try first line measures to manage hypertension including lifestyle changes and step wise therapy. If a person has malignant hypertension or resistant hypertension (3+ anti hypertensives are not cutting it) then I would certainly refer the patient to a specialist. It is true that there are NPs and PAs that work in specialty areas. They may or may not not see the patient for an "initial" consultation and may only see them for follow up visits after they have been evaluated by an MD. These providers may have additional training but there is no specific certification exam (ANCC, AANP, etc) that they have to complete to practice in their specialty.

On another note, any advice re doing a DNP program in mental health versus a post master's certificate?

Sailrmar9 · Feb 16, 2017

Haha, I was going to make a joke not to get me going about when one of the pyschiatrists I work with checks a TSH and it is 5.25 and they say "follow up with primary care" and don't bother to check free T3/T4 :yawn:

Jules A, MSN · Feb 16, 2017

Haha, I was going to make a joke not to get me going about when one of the pyschiatrists I work with checks a TSH and it is 5.25 and they say "follow up with primary care" and don't bother to check free T3/T4

Dang an amateur making us look bad, lol. I think TSH might be somewhat stress sensitive because its not uncommon to have elevation upon acute admission but upon recheck with free T4 :) its usually unremarkable.

JellyDonut · Feb 17, 2017

I think much of it has to do with the fact that there is a Psych specialty track so therefore those who don't have it and are attempting work solely in psych have not received what is the established education minimum requirements.
Hopefully the adult NPs you speak of treating psych are in fact only doing the very basics for depression etc. because imo if an appropriate trial of 2 SSRIs doesn't cut it the patient needs to be referred to a mental health provider. You wouldn't believe the screwed up regimens I'm asked to take over most all of course including a PCP created benzodiazepine dependence.

FNP programs cover *Pediatric * OB/GYN *Psych and all these have specialty tracks in the NP programs. I could actually get a job where all I see are children or pregnant women, but you are saying psych would somehow be different?

I agree with you, but it is true that I could work in a peds or OB/GYN clinic and no one would question it (much). So why not psych? Granted, I never ever want any roles in any of those practices and will always defer to those who know more than me in those areas but I can see the argument those who wish to go that route with an FNP could make.

Jules A, MSN · Feb 18, 2017

FNP programs cover *Pediatric * OB/GYN *Psych and all these have specialty tracks in the NP programs. I could actually get a job where all I see are children or pregnant women, but you are saying psych would somehow be different?
I agree with you, but it is true that I could work in a peds or OB/GYN clinic and no one would question it (much). So why not psych? Granted, I never ever want any roles in any of those practices and will always defer to those who know more than me in those areas but I can see the argument those who wish to go that route with an FNP could make.

The amount of psych, OB or peds you get in FNP, and I know because I'm a FNP also, is so minimal compared to the specialty tracks that I can't believe any states or NPs feel they have received a sufficient education to practice as a specialist, especially OB. In my FNP class they told us to toss the idea that "FNPs can do anything" and that if we wanted to work in acute care we were in the wrong program.

I can't speak for other states but in mine where there is a specialty track offered such as Women's Health NP or Psychiatric Mental Health NP the BON doesn't take too kindly to what they consider practicing outside your scope. I know a FNP practicing exclusively in psych who got her licensed sanctioned. Its just not a chance I'd be willing to take because like with anything its all well and good until the doo doo hits the fan.

elkpark · Feb 18, 2017

FNP programs cover *Pediatric * OB/GYN *Psych and all these have specialty tracks in the NP programs. I could actually get a job where all I see are children or pregnant women, but you are saying psych would somehow be different?
I agree with you, but it is true that I could work in a peds or OB/GYN clinic and no one would question it (much). So why not psych? Granted, I never ever want any roles in any of those practices and will always defer to those who know more than me in those areas but I can see the argument those who wish to go that route with an FNP could make.

At the risk of sounding like a broken record, once again: If you were showing up, not at your PCP's office, but at a psychiatric practice seeking specialized psychiatric services for yourself or a family member, would you find it reasonable and acceptable to be seen by an FNP who is generally trained and just prefers to work in psychiatry, rather than being evaluated and treated by someone who is specifically trained and credentialed in psychiatry?

I see FNPs post here all the time about how my training covered X, Y, and Z, so I'm qualified to work in those specialty areas; why wouldn't I be able to? And I always wonder how they would like it, as a recipient of care rather than a provider, to go to a specialty practice (not just psychiatry; any specialty area) seeking specialized services, and be seen by someone who was trained as a generalist and doesn't have any specialized training or credentials. Maybe I'm the oddball here, but I would not find that acceptable. To me, it's one thing to go to your PCP's office with a specific OB or psychiatric, or whatever, complaint with the understanding that your PCP is a generalist and you're comfortable with that (I've done it myself), but presenting to a specialty practice because you are seeking specialized service and treatment is an entirely different matter.

JellyDonut · Feb 19, 2017

At the risk of sounding like a broken record, once again: If you were showing up, not at your PCP's office, but at a psychiatric practice seeking specialized psychiatric services for yourself or a family member, would you find it reasonable and acceptable to be seen by an FNP who is generally trained and just prefers to work in psychiatry, rather than being evaluated and treated by someone who is specifically trained and credentialed in psychiatry?
I see FNPs post here all the time about how my training covered X, Y, and Z, so I'm qualified to work in those specialty areas; why wouldn't I be able to? And I always wonder how they would like it, as a recipient of care rather than a provider, to go to a specialty practice (not just psychiatry; any specialty area) seeking specialized services, and be seen by someone who was trained as a generalist and doesn't have any specialized training or credentials. Maybe I'm the oddball here, but I would not find that acceptable. To me, it's one thing to go to your PCP's office with a specific OB or psychiatric, or whatever, complaint with the understanding that your PCP is a generalist and you're comfortable with that (I've done it myself), but presenting to a specialty practice because you are seeking specialized service and treatment is an entirely different matter.

I personally do not feel qualified as an FNP to work solely in Psych, Peds or OB. Yikes, I would not even want to consider either as my program briefly considered each of these topics. However, I am an FNP who works in a specialty and see patients for specialty care. Granted, my program did not prepare me for my role. I spent oodles of time being trained and reading everything i could to feel competent. I put in the hours and asked questions until people actively avoided me just to get to the point where I now feel like and expert. So when a patient sits in the exam room with me they have access to an expert. School did not give me this - I developed and worked my behind off for it. And now other physicians seek me out for my advice. So maybe an FNP can work in a specialty area and be respected, it is not all that far of a stretch of the imagination.

Jules A, MSN · Feb 19, 2017

So maybe an FNP can work in a specialty area and be respected, it is not all that far of a stretch of the imagination.

Absolutely and my opinion is as long as it isn't a specialty with a board certification then have at it if someone will train you...and charge a pretty penny because all specialties should be making significantly more than a GP. :)